WHEN IS AN EYE EXAM "ROUTINE"? By Dr. Mark German, Optometrist at Lakeshore Eye Care Professionals
Just one of the many confusing things about insurance for eye care is when to use your “Vision Plan” and when to use your regular medical insurance. Not everyone has a Vision Plan but if they do it is often an added benefit that either the patient or their employer pays extra for. It may also include a discount on glasses or contact lenses every 1-2 years.
Vision Plans are intended for routine care that may not be covered by medical insurance. It is for patients who have no medical or surgical eye problems and come in every couple years to get their eye glasses prescription checked. While the exam is pretty much the same as that done for someone using their medical insurance, the reason for the visit is the key.
If a patient has diabetes, cataracts, macular degeneration, glaucoma, floaters, rapid change in vision, eye pain, red eyes or any other vision or eye problem, then this is a medical visit and should be billed to the patient’s medical insurance.
Sometimes patients are paying for a Vision Plan that they don’t need. Let’s say they have macular degeneration and the Vision Plan costs them more than the discount on glasses it provides. They would be better off just paying for their glasses outright as their exam will be billed to their medical insurance.
Still confused? Our staff will be happy to help you decide which plan is the most appropriate for your visit. But if you do have both a Vision Plan and medical insurance, be sure to bring both cards to each appointment.
Dr. Mark German is an optometrist practicing at Lakeshore Eye Care Professionals in Mequon and Saukville, Wisconsin. He welcomes patients of all ages to his practice and accepts most insurance plans.
For more information visit www.LakeShoreVision.com or call 262-241-1919.